Overview

Osteomyelitis is a serious bone infection caused by bacteria or fungi, leading to inflammation of the bone and surrounding tissues. The condition can be acute, developing rapidly over days or weeks, or chronic, persisting for months or even years. Osteomyelitis can affect individuals of all ages but is more common in children, older adults, and people with weakened immune systems. Without timely treatment, osteomyelitis can cause permanent bone damage, joint problems, or even life-threatening complications.

Causes

Osteomyelitis occurs when bacteria or fungi enter the bone, either through the bloodstream, nearby infected tissue, or direct contamination. Common causes include:

• Hematogenous spread: Infection spreads through the bloodstream from another infected area, commonly seen in children.
• Direct contamination: Open fractures, surgical procedures, or deep wounds can introduce bacteria directly into the bone.
• Contiguous spread: Infection from nearby tissues or joints, such as diabetic foot ulcers, can spread to adjacent bone.
• Common bacteria: Staphylococcus aureus is the most frequent cause, including methicillin-resistant strains (MRSA).
• Fungal infections: Fungal osteomyelitis is rarer but may occur in immunocompromised patients or in specific endemic regions.

Symptoms

The symptoms of osteomyelitis vary depending on the type, location, and duration of the infection. Common signs and symptoms include:

• Severe bone pain: Persistent, localized pain in the affected bone area.
• Swelling and redness: The area over the infected bone may appear swollen, warm, and red.
• Fever and chills: Often present in acute osteomyelitis, indicating systemic infection.
• Fatigue: Generalized tiredness and weakness due to infection.
• Restricted movement: Reduced mobility or stiffness if the infection involves joints.
• Drainage: Pus or fluid may drain from wounds or sinus tracts in chronic cases.
• Delayed healing: In post-surgical cases, delayed wound healing can signal underlying bone infection.

Diagnosis

Diagnosing osteomyelitis involves a combination of clinical evaluation, imaging studies, and laboratory tests:

• Physical examination: Doctors check for localized tenderness, swelling, and other signs of infection.
• Blood tests: Elevated white blood cell count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) indicate inflammation or infection.
• Blood cultures: Help identify the causative organism, especially in hematogenous cases.
• Imaging studies: X-rays may show bone changes after 10–14 days; MRI and CT scans provide more detailed images of bone and soft tissue involvement.
• Bone biopsy: A definitive diagnostic method involving sampling of bone tissue for microbiological and pathological examination.

Treatment

Early treatment is crucial to prevent permanent bone damage. Treatment strategies include:

• Antibiotics: High-dose intravenous (IV) antibiotics for 4–6 weeks, followed by oral antibiotics, depending on the severity and causative organism.
• Surgery: Surgical debridement to remove infected or necrotic bone tissue is often necessary, especially in chronic osteomyelitis.
• Drainage: Abscesses or infected fluid collections may require drainage.
• Stabilization: In cases involving fractures or severe bone destruction, orthopedic stabilization with rods, plates, or external fixation may be needed.
• Treatment of underlying conditions: Managing diabetes, vascular diseases, or immune suppression improves outcomes and reduces recurrence risk.
• Pain management: Analgesics are used to control pain during recovery.

Prognosis

The prognosis for osteomyelitis depends on the patient’s overall health, the speed of diagnosis, and the treatment approach:

• Good outcomes with early treatment: Acute osteomyelitis treated promptly often results in complete recovery.
• Risk of chronicity: Delayed diagnosis can lead to chronic osteomyelitis, requiring long-term treatment and repeated surgeries.
• Functional limitations: Severe or recurrent cases may lead to joint stiffness, limited mobility, or bone deformity.
• Increased risk in certain groups: Diabetics, immunocompromised individuals, and those with poor circulation have higher risks of complications and recurrence.
• Regular follow-up needed: Close monitoring after treatment is important to detect and manage any signs of relapse.

With timely and comprehensive care, most patients with osteomyelitis can achieve good outcomes and prevent serious long-term complications.